Search

The prognosis of melanoma patients who are diagnosed with multiple primary lesions remains controversial. We used a large population-based cohort to re-examine this issue, applying a delayed entry methodology to avoid survival bias. Of 32,238 eligible patients diagnosed between 1995 and 2008, 29,908 (93%) had a single invasive melanoma, 2,075 (6%) had two, and 255 (1%) had three. Allowing for differences in entry time, 10-year cause-specific survival for these three groups was 89% (95% confidence interval [CI] = 88–90%), 83% (95% CI = 80–86%), and 67% (95% CI = 54–81%), respectively. After adjustment for key prognostic factors, the hazard ratio of death within 10 years from melanoma was two times higher for those with two melanomas (hazard ratio = 2.01, 95% CI = 1.57–2.59; P< 0.001) and nearly three times higher when three melanomas were diagnosed (hazard ratio = 2.91, 95% CI = 1.64–5.18; P< 0.001) compared with people with a single melanoma. Melanoma-specific mortality remained elevated after adjusting for maximum thickness or ulceration of any melanoma regardless of the index tumor. After appropriately accounting for the interval between diagnosis of the first and subsequent melanomas, patients with multiple invasive melanomas have significantly poorer survival than patients with a single invasive melanoma.

IMPORTANCE: Merkel cell carcinoma (MCC) is an uncommon but highly invasive form of skin cancer. The mechanisms that cause MCC are yet to be fully determined. OBJECTIVES: To compare the incidence and survival rates of MCC in Queensland, Australia, known to be a high-risk area, with MCC incidence and survival elsewhere in the world. We also analyzed incidence trends and differences in survival by key demographic and clinical characteristics. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of population-based administrative data for MCC collected by the Queensland Cancer Registry and supplemented with detailed histopathologic data. Deidentified records were obtained of all Queensland residents diagnosed as having MCC during the period from 1993 to 2010. A subsample of histopathologic records were reviewed by a senior dermatopathologist to determine the potential for misclassification. A total of 879 eligible cases of MCC were included in the study. MAIN OUTCOMES AND MEASURES: Incidence rates were directly age standardized to the 2000 United States Standard Population. Trends were examined using Joinpoint software with results expressed in terms of the annual percentage change. The period method was used to calculate 5-year relative survival, and adjusted hazard ratios were obtained from multivariate Poisson models. RESULTS: There were 340 cases of MCC diagnosed in Queensland between 2006 and 2010, corresponding to an incidence rate of 1.6 per 100 000 population. Men (2.5 per 100 000) had higher incidence than women (0.9 per 100 000), and rates peaked at 20.7 per 100 000 for persons 80 years or older. The overall incidence of MCC increased by an average of 2.6% per year from 1993 onwards. Relative survival was 41% after 5 years, with significantly better survival found for those younger than 70 years at diagnosis (56%-60%), those with tumors on the face or ears (51%), and those with stage I lesions (49%). CONCLUSIONS AND RELEVANCE: Incidence rates for MCC in Queensland are at least double those of any that have been previously published elsewhere in the world. It is likely that Queensland’s combination of a predominantly white population, outdoor lifestyle, and exposure to sunlight has played a role in this unwanted result. Interventions are required to increase awareness of MCC among clinicians and the public.

IMPORTANCE Melanoma survivors are known to have a highly elevated risk of subsequent primary melanomas. OBJECTIVE To determine the relative risk of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma, with a focus on body site. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using population-based administrative data for melanoma diagnoses collected by the Queensland Cancer Registry, Queensland, Australia. Deidentified records of all cases of melanoma among Queensland residents during the period 1982-2005 were obtained and reviewed to December 31, 2010. There were 39 668 eligible cases of first primary invasive melanoma and 22 845 cases of first primary in situ melanoma. MAIN OUTCOMES AND MEASURES Standardized incidence ratios (SIRs), a proxy measure for relative risk, were calculated by dividing the observed number of subsequent primary invasive melanomas by the product of the strata-specific incidence rates that occurred in the general population and the cumulative time at risk for the cohort. Synchronous subsequent melanomas (diagnosed within 60 days of the first primary melanoma) were excluded. Differences between SIRs were assessed using multivariate negative binomial regression adjusted for sex, age group, time to second diagnosis, and body site and expressed in terms of adjusted SIR ratios with corresponding 95% CIs. RESULTS There were 5358 subsequent primary invasive melanomas diagnosed, resulting in SIRs of 5.42 (95% CI, 5.23-5.61) and 4.59 (4.37-4.82) for persons with a first primary invasive or in situ melanoma, respectively. The SIRs remained elevated throughout the follow-up period. In general, subsequent primary invasive melanomas were more likely to occur at the same body site as the initial invasive or in situ melanoma. The largest relative risk was for females with a first primary invasive melanoma on the head followed by a subsequent primary invasive melanoma also on the head (SIR, 13.32; 95% CI, 10.28-16.98). CONCLUSIONS AND RELEVANCE Melanoma survivors require ongoing surveillance, with particular attention required for the body site of the initial lesion. Clinical practice guidelines have recognized the importance of monitoring for people with invasive melanoma; the results of the present study highlight the need for similar levels of supervision for those with a diagnosis of in situ melanoma.

Australia records the highest incidence of skin cancer in the world. In response to this, public education campaigns have incorporated messages about reducing sun exposure and avoiding sunburn. This study sought to describe the prevalence of and factors associated with sunburn in Queensland residents. The Queensland Cancer Risk Study was a population-based, cross-sectional survey of 9,298 respondents conducted via computer-assisted telephone interview during 2004. Sunburn prevalence and its association with socio-demographics and skin cancer risk variables were examined. More than two-thirds (70.4%) of respondents reported at least one episode of sunburn in the past 12 months, and one in 10 respondents reported at least one episode of severe sunburn in the past 12 months. Experiences of sunburn on two or more occasions were reported more frequently by males than females (57.6% versus 46.5%, p<0.001), and by nearly two-thirds (65.8%) of those aged 20–39 years compared to 48.0% of 40–59 year olds, and 26.7% of 60–75 year olds (p<0.001). Episodes of sunburn were strongly associated with being male (OR=2.20 95%CI 1.84–2.63) and being aged 20 to 39 years compared to 60 to 75 years (OR=9.79, 95%CI=7.66–12.50). Sunburn remains highly prevalent among Queensland residents particularly among men and in the younger age groups. More effective strategies and methods may be required to extend the influence of health promotion campaigns.

OBJECTIVE To assess physician, patient, and skin lesion characteristics that affect the number of benign skin lesions excised by primary care physicians for each skin cancer. DESIGN Prospective study collecting clinical, patient, and histopathologic details of excisions or biopsies of skin lesions by random samples of primary care physicians. SETTING Southeast Queensland involving traditional family medicine physicians (n = 104; response rate, 53.9%) and family medicine physicians working in 27 primary care skin cancer clinics (n = 50; response rate, 75.0%). PARTICIPANTS Of 28 755 skin examinations recorded during the study, 11 403 skin lesions were excised or biopsied; 97.5% of the excised lesions had clinical and histologic diagnoses recorded. MAIN OUTCOME MEASURES Number of lesions needed to excise or biopsy (NNE) for 1 melanoma (pigmented lesions only) and NNE for 1 nonmelanoma skin cancer (nonpigmented lesions only). RESULTS The NNE for nonpigmented lesions (n = 8139) was 1.5 (95% confidence interval, 1.4-1.6) and for pigmented lesions (n = 2977) was 19.6 (16.2-22.9). The NNE estimates were up to 8 times lower if the physician thought the lesion was likely to be malignant and up to 2.5 times higher if there was strong patient pressure to excise. The NNE estimates varied by other physician-, patient-, and lesion-related variables. CONCLUSIONS Clinical impressions of excised skin lesions were strongly associated with NNE estimates. By focusing on pigmented skin lesions and by addressing the physician- and patient-specific factors identified, the effectiveness of future training for primary care physicians in the clinical management of skin cancer could be improved.Arch Dermatol. 2008;144(11):1468-1476--

OBJECTIVE To examine the relationship between melanoma thickness and reported time from first recognition and from first physician contact to the diagnosis of invasive melanoma. DESIGN Telephone survey of patients recently diagnosed as having melanoma, combined with relevant pathological data (including melanoma thickness and morphologic structure) from the population-based Queensland Cancer Registry. A test-retest study (n = 176) was also conducted. SETTING Population-based study in Queensland. PARTICIPANTS Residents of Queensland (n = 3772) who had been diagnosed as having invasive melanoma between January 1, 2000, and December 31, 2003. MAIN OUTCOME MEASURES Prepresentation time (time between first noticing a suspicious spot and the first physician visit), postpresentation time (time between the first physician visit and diagnosis), and total time to diagnosis (time from initial detection of the melanoma to diagnosis). RESULTS With 1 exception, we found no significant association between melanoma thickness and reported time to diagnosis for all melanomas combined, superficial spreading melanomas, or nodular melanomas. The exception was a positive association between melanoma thickness and postpresentation delay of physician-detected nodular melanomas. The reliability study gave intraclass correlation coefficients of 0.85 to 0.90 for the measures of intervals. CONCLUSIONS This large study demonstrates no clear relationship between the melanoma thickness when diagnosed and the time from first recognition of changes or from first physician examination to diagnosis. This may be because of varying biological characteristics of melanomas, as well as methodological limitations of retrospective studies when trying to measure this complex association.Arch Dermatol. 2006;142:1422-1427--

The screening behavior and screening outcomes of men age ≥50 years was investigated within a randomized controlled trial of a community‐based intervention of screening for melanoma, consisting of a community education program, an education program for medical practitioners, and the provision of dedicated skin‐screening clinics.Data from cross‐sectional telephone surveys before (559 completed interviews), at the end (591 completed interview), and at 2 years after the intervention (445 completed interviews) were analyzed. In addition, the authors analyzed data from skin‐screening clinics within the intervention program (3355 men age ≥50 years participated).During the intervention period men age ≥50 years increased both their screening behavior and intention to screen. Those men age ≥50 years who reported a past history of removal of a mole as well as other risk factors for skin cancer and positive attitudes toward screening were more likely to participate in skin screening across time. Men age ≥50 years accounted for 20.5% of all skin‐screening clinic attendees, 31.3% of those referred for a suspicious lesion, 48.5% of melanomas, and 45% of all keratinocyte carcinomas diagnosed within the screening program, respectively.The intervention program successfully motivated men age ≥50 years to attend screening for skin cancer, resulting in the highest yield of skin cancer within this subgroup of the population. Messages addressing skin cancer risk factors and attitudes toward skin cancer and screening could be used to target a screening program for melanoma toward men age ≥50 years. Cancer 2006. © 2006 American Cancer Society.

The incidence of skin cancer is rising in many populations around the world. In Australia, men have both the highest incidence of thick melanoma and an increased risk of dying from this disease. Skin screening may provide a method for detecting lesions at an earlier stage. This study sought to assess the impact of two methods of encouraging men to attend free open-access skin screening clinics. A randomised controlled trial of two recruitment methods. Subjects comprised all men aged 30 to 79 years (n=1,322) from a rural community. We randomly allocated 50% (661) to receive a personalised letter with the remaining 50% receiving the letter plus an additional brochure. Both groups were similar in age distribution. A total of 250 men (18.9%) attended the skin screening clinic. Overall, there was no difference in rates of attendance between the two groups. Younger men (30 to 49 years) in the letter and brochure group were more likely to attend a clinic, while men 50 years in the letter only group were more likely to attend (p=0.01) These results indicate that a personalised letter or targeted approach of invitation is effective in encouraging men to attend a skin screening clinic. The addition of health information through the use of a glossy brochure did not increase screening participation among men over 50. Health information is not a significant factor in the decision to attend skin screening for men over 50. This may not be the case for younger men.